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General NPI Number Information
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NPI Number | 1790394393
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Entity Type | Organization
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Legal Business Name | ROBERT W BASSHAM DDS PA
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Dates
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Enumeration Date | 07/29/2020
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 669 ADDISON DR
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City | WYNNE
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State | AR
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Zip | 72396-1602
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Country | US
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Telephone | 870-238-7570
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Fax | 870-238-1208
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Provider Business Mailing Address
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Address Line | 669 ADDISON DR
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City | WYNNE
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State | AR
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Zip | 72396-1602
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Country | US
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Telephone | 870-238-7570
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Fax | 870-238-1208
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. HOLLY GENE BASSHAM
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Credential |
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Telephone | 870-238-7570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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